0203-265 (SATT)LICENSED CONTRACTOR DECLARATION:
U) I hereby affirm under penalty of perjury that I am licensed, under provisions of
Frli ` 'Chapter 9 (commencing with Section 7000) of Division 3 of'the Business and
NLLJ Professionals Code, and my License is in full force and effect.
0 =) ch License # Lic. Class Exp. Date
CY in
LLJ
oZ Date a"'�� "'p Signature of Contractor
CD 0
OWNER -BUILDER DECLARATION
J
W LUI hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale ,(Sec. 7044, Business & Professionals Code). „
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct tqe project (Sec. 7044, Business & Professionals
Code).
( ) ' I am exempt under Section B&P.C. for this reason
O N Date Signature of .Owner
rn
a Q WORKER'S COMPENSATION DECLARATION
p 2
Cr I hereby affirm under penalty of perjury one of the following declarations:
LO O () 1 have and will maintain a certificate of conser t to self -insure for workers'
X w ,compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
M Q .0 ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
Il f— permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier STA; ; P I? Policy No. 103616.02
oo
rC)
J (This section need not be completed if the permit valuation is for $100.00 or less).
4I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provis"ions�f%%
Date. �'�' �r M CL t Applicant 'S r.-�k t-��3rr-a°
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crim nal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant. to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees. .
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180' days from date of issuance of 'such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certifyothat I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building:
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property.for inspection pur oses.
Signature (Owner/Agerit) = Via° �1 , Date
�JJ '
G PERMIT PERMIT #
BUILDING
_UILDI_
DATE y VALUATION LOT TRACT
' ✓ -:"a cx I �2(?: B19V38 I 3 11
JOB SITEC
ADDRESS 4.7-•736 SUMAC C &IRi'a..
APN
6494 G-00
OWNER �� _
CONTRACTOR /yDESIGNER /ENGINEER.
,� W.��Tb+vpi,�' a, LPi.�.i
.t�1 ar ., : •t"° dba D $TZ CUSS b .
74 -7 60 -1I01TWAY 111 11,200
18-600 H[GHWAY 1 11.
1 Sl�it1 CA 922210
LA Q1,WA €'A. 92.253
USE OF PERMIT
MIGLEFAMUFATLACPM
SPA - BLDG. 1 , UNIT 39 PIJkV IA. PEkIbI;I1 DOM NOT iNCLUDE
POOL, SPA, OWCK OR D.RI k;V�'AY A PFROACK 75% itBi3t7C T10k4
IN PAN CHECK "M FOR MULTI''PLC ISSUANCE OF SAME I'I.(1,'A!'1YP&
6TIf.ACd CONSTRUCTION U .
NSTIM TM COST OF C"ONtOWI7CMON
X020
C CN: i'RUCT1014 FEE 101.000.418.000 $ Ig ISO
PLAN CHi 1a: PER 101-000439-318 $97.85
MECHANICAL .PER 101-000-421-000 $391"
El fZTPJCAI. PE,19 101-000-420-000 $65.36
PLUMBING "Z 101-000-419-000 $3IS.io
,i
480
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ 67
Underground Ducts
Forms &Footings
D
Ducts
Slab Grade
A
Return Air
Steel
—2,
Combustion Air
Roof Deck
p_ . 45)2--
Exhaust Fans
O.K. to Wrap
, p
F.A.U.
Framing
_' ..�-i
Compressor
Insulation
y 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
� � ✓ kJ
Co-o2�S�-a z
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection ?, o S
Gas Piping
Encapsulation
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) , p
COMMENTS -J�
INSULATION CEUTIFICATE IC -T.
Sitr Ad''ress
Pernl:Nunbzr
Description of Installation
1. ROOF
T _ ` -
ThicknesS (inc: cs) \31( Ti -::r �. Rcsis:anc: (R-Va!uc) 3
2. CEILING '
Bat: o: B'an'.;--t Type t'Y. � E:s :e NameM�.1'1 LQ
Thickr:css (inc`. s1.t
, X90 ThL rr _: ^sis:ar.c (ti- 'wlu
Loo.c Fill Type`Cc fit'\ Brand ' 'l
Cor.tractor'9 rni installed weighYp- lb L4i^i ^um t:Zickness l0_ � inches
M anufacturces in -stalled weight per square foot to achieve T;.cmnal Rcsiva ce (R -Val: --e)
3. EXTERIOR WALL
Material Brand N [
Thickness (inchcs) Thermal Resistance (R-Valuc)
B . Exterior l,t_.C..uo
Material y�G S Brzr.d Na :e �(
Thickness (inchcs) Ti:e=,ai Resistance (R -Valve)
RAISED FLOOR
Thic!cncss (inc`.-s)
SLAB FLOOR,TERI`fETER
Ma Leal
Thickn-,ss (inches)
Pcric:c:cr Insula, icn Dcpth (inches)
FOU\ DA TION. ViA LL
Nj.ate.ia! —Pnn-+ \'a::::
Thic''K ess (inchcs) Tce=a' Resis:ar.ce (R -Value)
Declaration
I hereby c�r'; th3! !:._ 3bovc ir-sul3tton .v3s ins!?ll_d Ln th= cC3::cn 11 Ccnfc rand: W1!4 Lhc CL'
Energy E„7 hie:S:on-1 for residcntial baildi.gss (Title 2,, Pa' S, California Coc: cf Rug_la cns) ss indicat-,-d ca the
Cc^iGc3te cf Co :.; !:3 c u a plicabk:.
xb� 3 - Q I
1!e 13 S;i2n _. _, Ds:. (Co. Nano) GR
Ger.:. sl Ccr:acror (Co. Vane) OR Owrc.
i
t:CT1 t �13tL.CC, D3tc
G:'_na N3..._
1 .. ....ii R�sistancf (7R -Val --i--)
13, -and, Name
T crrnal Resistance (R -Value)
1-5:allir,g Sc` -onsactor (Co. Nanc) OR
Ccr :ral C, -r.!. -ac -.or (Co. N3rnc) OR 0`x'n:r
1:-s:311i; S.:`co=3c!or (Co. Nano) OR
Cc.._.a! Ccr...-_:or (Co. N'.3 OR Ow•r,er
"' A•3o
1
Standard Notice of Work Completed and Not Completed
NOTICE - All reccommedations may not have been completed. See below- Recommemedations not completed.This form is prescribled by the Structural Pest
Control Board, with whom a copy must be filed by license within 5 days after completion of work under contract.
THIS IS A NOTICE OF COMPLETION ONLY, NOT AN INSPECTION REPORT
ADDRESS OF BLDG STREET CITY:, DATE OF COMPLETION'
PROPERTYSSt. La Quinta CA 92253
47-736 Sumac INSPECTED: CO.CODE 33 08/20/2002
FARMER TERMITE CONTROL AFFIX STAMP TO
P.O. BOX 5155 BOARD COPY ONLY
BELLFLOWER CA 90706
(888) 340 -BUGS (562) 920-7571
I FIRM LICENSE NUMBER PR1401 I COMPLETION STAMP NUMBER
Notice of completion
Sent To and date : 03/13/2003
Owner's Name and Address:
Copies sent to
This is to certify that the folowing recommendations on the above designated property, as outlined in STANDARD INSPECTION REPORT NO
date : / / REGISTRATION STAMP NO: have
been and/or have not been completed.
Recommendations completed that are in accordance with Structural Pest Control Board's rules and Regulations:
Recommendations completed that are considered secondary measures under section 1992 of Structural Pest Control Board's rules and Regulations:
.d
o
Recommendations not completed by this firm
Cost: $ 70-00
Inspection fee : $ 0.00
Others : $ ` 0.00
Total: $ 70-00
Estimated Cost: $
Remarks:
A soil pre-treatment was performed nn this pro�erty in accordance with Structural Pest Control Board regi lationg-
Signature
If you have questions regarding the work as outlined above,you should first contact the licensee noted above. Id satisfaction is not obtain you may contact
the Structural Pest Control Board at
Los Angeles - 213-620-2255
Sacramento - 916-920-5323
You are entitled to obtain copies of all reports and completion notices on this property filed with the Board during the preceding two years upon
payment of a $2.00 search fee to : The Structural Pest Control Board , 1422 Howe Ave.,Ste. 3, Sacramento,Califomia 95825-3280.
AT21:1120030313 '
Certificate -of Occupancy
City of -La Quinta
Building and Safety Department.
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various .ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 47-736 SUMAC STREET U-38
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-265
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: 74-760 HIGHWAY 111 #200
'City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
Building_ Official.
POST IN A CONSPICUOUS PLACE